An improved method of assessing esophageal emptying using the timed barium study following surgical myotomy for achalasia.
BACKGROUND
The timed barium study (TBS) is used to assess esophageal emptying in patients with achalasia. Improvement in emptying correlates with outcome after endoscopic therapy, but the results of the TBS have been variable after myotomy. Our aim was to evaluate a new method for assessing improvement in emptying after myotomy.


METHODS
A TBS was performed before and 3-6 months after myotomy in 30 patients. Emptying was assessed by measuring the percent difference in area of the barium column on films obtained 1 and 5 min after ingesting 150 ml of barium. Initial esophageal clearance was also assessed by comparing the area of the barium column on 1-min images obtained before and after therapy. Both measures were compared to clinical outcome.


RESULTS
After myotomy, 21 patients (70%) had no symptoms, four (13%) had mild, and five (17%) had moderate/severe symptoms. Using the standard method, esophageal emptying before and after surgery were not significantly different (25% vs. 37%; p = 0.22) and did not correlate with clinical outcome. In contrast, initial esophageal clearance improved significantly (median 81%) and correlated with clinical outcome.


CONCLUSIONS
Esophageal emptying measured by the standard method is not useful to assess outcome after myotomy. However, initial esophageal clearance correlates well with clinical outcome.
Oezcelik
Arzu
A
Department of Surgery, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, Los Angeles, CA 90033, USA.
Hagen
Jeffrey A
JA
Halls
James M
JM
Leers
Jessica M
JM
Abate
Emmanuele
E
Ayazi
Shahin
S
Zehetner
Joerg
J
DeMeester
Steven R
SR
Banki
Farzaneh
F
Lipham
John C
JC
DeMeester
Tom R
TR
D000284:Administration, Oral; D000328:Adult; D001466:Barium Sulfate / Q000008:administration & dosage; D003287:Contrast Media / Q000008:administration & dosage; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011184:Postoperative Period; D011312:Pressure; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate